1 1". I  l« 


FIRST   SETMES  NO.  39 


DECEMBER  15,   1920 


UNIVERSITY  OF  IOWA 
STUDIES 


STUDIES  IN  CHILD  WELFAEE 


VOLUME  I 


NmiBER  3 


A  PRELIMINARY  STUDY  IX 
CORRf:CTI\  E  SPEECH 


bv 


SARA  ^\.  STINCIIFIELD 


PUBLISHED    BY    THE    UNIVERSITY,    IOWA    CITY 


Issued  semi-monihly  throughout  the  vear.  Entered  at  the  post  office  at  Iowa  City, 
Iowa,  as  seciiiid  class  matter.  Acceptance  for  mailing  at  special  rates  of  postage 
providcfl   for   in   section    IIO;'.,    Act   of   October   3,    1917,    authorized  on   July    3,    1.918 


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University  of 
Connecticut  Libraries 


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t5h 

UmVEESITI  OF  IOWA  STUDIES   Hz^ 
IN  CHILD  WELFAEE  hZ^ 


Professor  Bird  T.  Baldwin,  Ph.  D,,  Editor 


FROM  THE  IOWA  CHILD  WELFARE  RESEARCH  STATION 


VOLUME  I  NUMBER  3 


A  PRELIMINAEY  STUDY  IN 
COERECTIVE  SPEECH 

by 

SARAM.  HcKwV^;,        . 


PUBLISHED  BY  THE  UNIVEESITY,  IOWA  CITY 


STUDIES  IN  CHILD  WELFARE 

Pages 

1.  The  Physical  Groivth  of  Children  from  Birth  to 

Maturity,  by  Bird  T.  Baldwin  (in  press)  250 

2.  A  Survey  of  Musical  Talent  in  the  Public  Schools, 

by  Carl  E,  Seashore  36 

3.  A  Preliminary  Study  in  Corrective  Speech, 

by  Sara  M.  Stinchfield  36 

4.  An  Analytic  Study  of  a  Class  of  Five  and  Six 

Year  Old  Children,  by  Clara  H.  Town  (in  press)  100 

5.  Investigations  in  the  Artificial  Feeding  of  Children, 

(reprints)  by  Amy  L.  Daniels,  Albert  H.  Bypield, 

and  Rosemary  Loughlin  24 

6.  Child  Legislation  in  Iowa,  by  Frank  C.  Horack  40 


UNIVERSITY  EXTENSION  BULLETINS 
BY  MEMBERS  OF  RESEARCH  STATION  STAFF 
57.    Diet  for  the  School  Child,  by  Amy  L.  Daniels 
59.     The  Physical  Growth  of  the  School  Child,  by  Bird  T.  Baldwin 
65.    Feeding  the  Baby,  by  Amy  L.  Daniels  and 
Albert  H.  Byfield 
School  Lunches  (in  press),  by  Amy  L.  Daniels 
Diet  Card  (in  press),  by  the  Staff 


CONTENTS 


Editok's  Foreword 5 

Introduction 7 

Observations  on  University  Observational  School  Pupils   .  8 

A   Tentative   Classification  and   Analysis   of   Defective 

Speech  Conditions  and  Causes  op  Speech  Disorders  .    .  9 

A  Keport  of  Two  Type  Cases  with  Outlines  of  Remedial 

Treatment,  Training  and  Results 18 

Materials  for  Speech  Examination 27 

Materials  for  Phonographic  Test  Records 30 

Sample  Speech  Drill  Charts 32 

Selected  References 35 


EDITOR'S  FOREWORD 

This  study  presents  in  a  practical  manner  a  brief  analysis  of  some 
common  speech  defects  among  young  children,  with  remedial  sug- 
gestions in  the  form  of  special  exercises.  A  more  detailed  account 
of  consecutive  work  with  two  stutterers  shows  the  significance  of 
nutrition,  orthodontic  treatment,  environment,  mental  attitude,  in- 
tellectual status  and  systematic  training. 

No  attempt  has  been  made  to  give  an  anatomical  description  of 
the  speech  organs  or  an  exhaustive  treatment  of  the  causes  of  speech 
defects.  The  selected  references  are  limited  to  those  bearing  di- 
rectly on  the  practical  problems  of  corrective  speech.  This  mono- 
graph is  a  portion  of  a  dissertation  presented  by  the  writer  in 
partial  fulfillment  of  requirements  for  the  degree  of  Master  of 
Arts  in  child  welfare. 

Miss  Stinchfield's  work  has  been  made  possible  through  the  cor 
operation  of  the  divisions  of  the  Research  Station,  the  Department 
of  Psychology,  the  Colleges  of  Medicine,  Dentistry  and  Education, 
and  the  Department  of  Public  Speaking. 

Bird  T.  Baldwin 

Office  of  the  Director 

Iowa  Child  Welfare  Eesearch  Station 

University  of  Iowa,  Iowa  City 

September,  1920 


A  PEELIMINAEY  STUDY  IN 
COKRECTIVE  SPEECH 

I.    INTRODUCTION 

The  greatest  progress  in  the  acquiring  and  perfecting  of  a 
technique  of  speech  is  made,  as  a  rule,  by  a  child  from  the  sixth 
month  to  the  end  of  the  third  year  of  age.  The  quality  of  the  child 's 
environment  and  the  training  in  these  early  years  is  of  special  sig- 
nificance to  the  investigator  in  speech  development. 

Young  animals  make  noises  as  an  instinctive  response  to  environ- 
mental or  internal  stimuli  and  babies  indulge  in  vocalization  in  the 
same  way  in  which  they  reach  and  grasp  for  objects  or  ceaselessly 
move  their  eyes  from  place  to  place.  Certain  of  these  chance  sounds 
resulting  from  accidental  positions  of  the  baby's  vocal  organs  tend 
to  be  reproduced  because  of  pleasant  results  of  either  approval  and 
admiration  of  its  efforts  or  satisfaction  of  its  wants.  Gradually 
these  sounds  become  associated  with  the  objects  or  activities  which 
they  represent.  The  sounds  which  shall  become  attached  to  an 
object  depend  on  the  language  environment  of  the  child.  One  child 
may  come  to  associate  the  sound  "bow  wow"  with  a  dog,  another 
will  say  "doggie",  and  a  third  may  say  "woof  woof",  depending 
largely  on  which  name  tends  to  become  fixed  as  a  result  of  parental 
approval.  Children  frequently  develop  a  language  of  their  own, 
intelligible  only  to  themselves  or  to  their  playmates.  "When  this 
mode  of  speech  has  once  become  established,  it  takes  careful  train- 
ing to  develop  more  desirable  speech  habits. 

Hand  in  hand  with  growth  in  control  of  the  speech  mechanism 
goes  the  development  of  normal  speech  so  that  between  the  fifth 
and  sixth  years,  or  by  the  time  the  child  enters  school,  the  early 
infantile  habits  of  erroneous  articulation  should  be  outgrown. 
When  "infantile  speech"  (baby  talk),  or  indistinct,  poorly  articu- 
lated speech  persists  into  the  fifth  year,  there  are  underlying  causes 
which  may  be  organic  and  functional,  of  which  the  speech  disturb- 
ance is  only  an  indication.    These  causes  may  be  classed  as  organic 


8  IOWA  STUDIES  IN  CHILD  WELFARE 

if  the  disturbances  of  the  speech  mechanism  are  due  to  physical 
defects  such  as  malformations  of  the  palate  or  uvula,  paralysis  or 
atrophy  of  nerves  and  muscles ;  or  functional  if  there  is  apparently 
no  defect  of  structure  but  an  interference  with  the  normal  action  of 
the  speech  mechanism  due  to  such  causes  as  insufficient  imagery, 
neurotic  disturbances,  or  similar  conditions.  The  distinction  is  an 
arbitrary  one  and  is  made  only  for  purposes  of  further  analysis  and 
classification. 

In  order  to  obtain  an  empirical  basis  for  corrective  speech  work, 
a  preliminary  study  was  made  with  one  hundred  thirteen  children 
in  the  first  six  grades  of  the  University  Elementary  School  of  the 
State  University  of  Iowa,  supplemented  by  observations  on  three 
hundred  children  in  the  public  schools  of  Pittsburgh,  Pennsylvania. 
The  results  make  it  possible  to  present  at  this  time,  a  tentative 
classification  of  some  of  the  common  faulty  speech  conditions  and 
causes  of  speech  defects.  As  examples  of  the  possibilities  of  the 
methods  in  remedial  treatment,  two  type  cases  of  stuttering  from 
Iowa  public  schools  are  discussed  in  detail.  A  scale  or  method  for 
speech  examination  is  appended,  together  with  a  list  of  selected 
references. 

II.     OBSERVATIONS  ON  UNIVERSITY  ELEMENTARY 
SCHOOL  PUPILS 

The  procedure  in  the  University  Elementary  School  consisted  in : 
(1)  tests  to  discover  individual  speech  disorders;  (2)  the  immediate 
correction  of  minor  defects  through  training;  (3)  educational,  med- 
ical or  orthodontic  treatment,  in  cooperation  with  the  teachers. 
University  specialists,  and  the  home. 

Among  the  children  examined  there  were  forty-five  cases  where 
organic  conditions  were  responsible  for  the  defect.  In  fifteen  addi- 
tional cases  the  speech  difficulty  seemed  to  have  a  functional  cause 
such  as  nervous  instability.  In  ninety-three  cases,  this  number  in- 
cluding, of  course,  some  of  the  cases  of  the  first  two  classes,  there 
was  a  functional  disturbance  evidenced  by  poor  speech  habits. 
Table  I  gives  the  distribution  of  the  types  of  speech  inaccuracies 
throughout  the  grades  surveyed. 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH   9 

TABLE   I 

Distribution  of  Organic  and  Functional  Speech  Defects  Among  One 

Hundred  Thirteen  Elementary  School  Pupils 


I.    Organic 

II.     Functional 

No.  of 

A,     Nervous 

B. 

Incorrect 

Pupils 

Grade 

Instability 

Speech  Habits 

in  Grade 

I 

5 

2 

10 

12 

II 

6 

2 

13 

15 

III 

7 

1 

15 

19 

rv 

11 

3 

23 

25 

V 

6 

2 

10 

16 

VI 

10 

5 

22 

26 

45  15  93  113 

The  chief  indications  of  inadequate  speech  development  in  the 
order  of  the  frequency  of  their  occurrence  among  these  children 
were:  tone  monotony,  poor  enunciation  and  articulation,  slurring 
(omission  of  sounds),  marked  mispronunciation,  inaudibility, 
"sluggishness"  (excessive  slowness),  nasality,  lisping,  faulty  res- 
piration, ''cluttering"  (excessive  rapidity),  stuttering  (repetition 
of  syllables),  and  "throaty"  tones. 

A  group  of  twenty-five  children  most  in  need  of  corrective  work 
were  selected  for  special  class  training  in  speech  with  good  results 
in  the  elimination  of  the  more  common  faults. 

III.    A  TENTATIVE  CLASSIFICATION  AND  ANALYSIS  OF 

DEFECTIVE  SPEECH  CONDITIONS  AND  CAUSES 

OF  SPEECH  DISORDERS 

CLASSIFICATION 

A.    Defective  Control  of  Breath 

Speech  conditions 

Breathing  on  an  inspiration  instead  of  an  expiration 

"Breathy"  tones 

Spasmodic  movements  of  diaphragm,  glottis,  and  larynx 
Causes 

Adenoids 

Diseases  of  naso-pharynx,  nasal  septum,  sinus  infection 

Hypertrophied  tonsils 

Poor  posture 

General  physical  debility 

Nervous  conditions  affecting  the  breathing  mechanism 


10  IOWA  STUDIES  IN  CHILD  WELFARE 

B.  Defective  Articulation 

Condition:  Mispronunciation 
Causes 

Malformations  of  oral  cavity 

Thickened  tongue 

Interdental  spaces 

Inaccurate  tongue  position 

Paralysis  of  parts  of  peripheral  speech  mechanism 

Defects  of  peripheral  sensory  mechanism,  especially  visual 
and  auditory 

Central  defects  in  motor,  sensory,  perceptual  or  imaginal 
areas 

Functional  nervous  disturbances 

Wrong  habits  of  speech 

Defective  mentality 
Condition:  Echolalia 
Causes 

Defective  mentality 

Infantile  speech  habits 
Condition:  ''Sluggishness" 
Causes 

Physical  debility 

Malnutrition 

Adenoids 

Hypertrophied  tonsils 

Defective  mentality 

Nervous  disorders 
Condition :  ' ' Cluttering ' ' 
Causes 

Nervous  disorders  and  psychical  condition 

Incorrect  speech  habits 
Condition:  Stuttering  and  stammering 
Causes 

General  physical  debility 

Shallow  breathing 

Nervous  disorders 

Psychotic  condition 

C.  Defective  Vocalization 

Condition:  Complete  absence  of  speech  or  absence  of  special 
tones 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH     11 

Causes 

Paralysis  of  parts  of  peripheral  speech  mechanism — lips, 
tongue,  larynx,  palate,  or  vocal  cords. 

Lesions  in  central  areas — motor,  imaginal,  association — or 
in  projection  fibres,  or  in  lower  nuclei 

Deafness 

Functional  nervous  disorders 

Psychotic  condition 
Condition:  Nasality 
Causes 

Cleft  palate 

Hair  lip 

Adenoids 

Deflected  septum 

Laryngeal  or  palatal  paralysis 

Persistence  of  wrong  habits  of  speech 

Lack  of  use  of  nasal  passages 
Condition:  Monotony 
Causes 

Cleft  palate 

Adenoids 

Deflected  septum 

Infected  tissues 

Peripheral  or  central  defects  in  nervous  mechanism 

Psychotic  conditions 
Condition:  Hoarseness,  harshness 
Causes 

Defect  of  vocal  cord 

Local  inflammation 
Condition :  ' '  Throatiness ' ' 
Causes 

Elongated  uvula 

Thick  tongue 

Hypertrophied  tonsils 

"Wrong  habits  of  speech 
Condition:  Non-sihilant  or  high  pitched  voice 
Causes 

Shallow  breathing 

Defect  of  vocal  cord 

Thymus  and  thyroid  disease 

Local  inflammation 


12  IOWA  STUDIES  IN  CHILD  WELFARE 

ANALYSIS   OF   DEFECTIVE   SPEECH    CONDITIONS   AND    CAUSES 

A.  Defective  Control  of  Breath 

One  of  the  most  important  factors  in  defective  speech  is  poor 
control  of  breath  during  speech.  This  lack  of  control  is  both  a 
symptom  of  disturbed  speech  functioning  and  a  cause  of  further 
speech  disorders.  Under  normal  conditions  the  motor  response  to 
the  speech  impulse  is  immediate  and  accurate.  Through  habit 
formation  the  child  gradually  gains  control  of  the  muscles  of  tongue, 
lips,  uvula,  and  larynx  until  the  process  of  phonation  has  become 
automatic  and  effortless.  Speech  disorders  are  almost  always  asso- 
ciated with  disturbances  in  the  normal  smooth  working  of  this 
process.  A  common  cause  of  faulty  respiration  is  the  obstruction  of 
the  respiratory  passages  by  adenoids,  hypertrophied  tonsils  and 
thyroid  glands  or  inflamed  tissues.  Other  contributory  causes  are : 
poor  posture,  general  physical  debility,  and  functional  nervous  con- 
ditions affecting  normal  breathing.  If  automatic  breathing  is  thus 
interrupted  the  child  speaks  in  a  jerky  manner,  attempts  phonation 
on  an  inspiration  instead  of  an  expiration,  or  produces  gasping  or 
'  *  breathy ' '  tones,  in  which  the  breathing  sounds  are  distinctly  audi- 
ble. In  extreme  cases  these  conditions  are  accompanied  by  spasms 
of  the  diaphragm,  rapid  pulse,  throbbing  arteries  and  great  mental 
excitement,  sometimes  with  fear.  The  development  of  breath  con- 
trol is  therefore  regarded  by  most  authorities  in  the  field  of  speech 
and  song  as  the  first  point  of  attack  for  the  correction  of  voca) 
defects. 

B.  Defective  Articulation 

Mispronunciation 
Under  the  head  of  mispronunciation  may  be  classed  a  variety  of 
symptoms  due  to  a  number  of  causes.  The  common  characteristic 
of  these  cases  is  the  fact  that  the  word  as  articulated  does  not  cor- 
respond to  the  printed  word  or  to  the  correct  sound.  Mere  in- 
ability to  read  fluently  can  scarcely  be  classed  as  a  speech  difficulty. 
There  are,  nevertheless,  cases  of  children  who  habitually  speak  with 
ease  but  hesitate  and  become  confused  when  confronted  with  the 
printed  page.  Another  more  serious  condition  is  lisping,  which  is 
defined  by  the  majority  of  authorities  in  the  field  of  speech  as  the 
substitution  of  other  sounds  for  s,  z,  sh,  and  zh  sounds  as  they 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH     13 

occur  in  various  combinations.  Frequently  the  fullness  and  dis- 
tinctness of  normal  enunciation  gives  place  to  a  blurred  effect.  The 
child  may  be  able  to  produce  the  individual  sounds  of  all  con- 
sonants accurately,  but  slurs  and  alters  them  when  they  "occur  in 
combinations.  Under  the  term  ''blurred  enunciation"  are  classified 
the  production  of  indistinct  initial,  middle  or  final  letters,  inaccu- 
rate prefixes,  diphthongs  and  consonant  combinations,  and  the  drop- 
ping of  syllables.  Another  class  of  mispronunciations  includes  cer- 
tain aphasie  conditions  in  which  there  is  distortion  of  words,  trans- 
position of  syllables  or  phrases,  or  utterance  of  meaningless  combi- 
nations of  words  and  sounds.  The  babbling  and  lalling  of  infants 
and  of  adult  idiots  are  similar  meaningless  combinations  of  sounds, 
due,  however,  to  different  causes. 

The  causes  of  mispronunciation  are  both  organic  and  functional ; 
in  fact,  so  closely  are  causes  related  in  most  cases  that  it  is  fruitl^s 
to  attempt  to  assign  to  each  its  share  in  producing  the  defect.  A 
common  cause  of  mispronunciation  is  the  poor  shape  and  size  of  the 
oral  cavity,  resulting  from  malocclusion,  high  palate,  inter-dental 
spaces,  thickened  tongue,  or  incorrect  placing  of  tongue  with  dis- 
tortion of  the  space  through  which  the  air  must  pass  for  correct 
articulation.  Lisping  is  especially  apt  to  occur  under  these  condi- 
tions. Mispronunciation  will  also  occur  if  there  is  paralysis  of  the 
muscles  and  nerves  governing  the  peripheral  speech  mechanism. 
For  example,  a  paralysis  of  the  facial  nerve  on  one  side  will  make  it 
impossible  for  both  sides  of  the  mouth  to  act  coordinately  in  shaping 
certain  letters.  Any  deficiency  in  the  peripheral  sensory  mechanism 
will  also  be  reflected  in  faulty  pronunciation,  since  accurate  per- 
ception is  the  basis  for  a  correct  concept.  A  child  who  is  myopic 
mispronounces  letters  he  does  not  clearly  see;  a  child  who  hears 
only  certain  tones  mispronounces  words  he  has  only  partially  heard. 
In  both  cases  a  false  concept  is  formed  as  a  basis  for  future  mis- 
pronunciation. Correction  of  these  defects  of  the  sense  organs  is 
possible.  This  is  not  true,  however,  with  another  class  of  causes  in 
which  there  are  central  defects  in  the  motor,  sensory,  perceptual  or 
imaginal  areas  that  render  impossible  the  correct  apprehension  of  a 
word  and  the  execution  of  the  vocal  act.  The  same  defect  is  pro- 
duced by  functional  nervous  disturbances  of  these  centers.  Incor- 
rect speech  habits,  sometimes  as  a  result  of  imitation,  are  another 
frequent  source  of  mispronunciation,     A  combination  of  organic 


14  IOWA  STUDIES  IN  CHILD  WELFARE 

disabilities  and  incapacity  for  rapid  formation  of  correct  habits 
would  account  in  large  measure  for  the  mispronunciation  and  other 
types  of  speech  defect  commonly  observed  in  mental  deficiency. 

The  speech  of  the  mentally  deficient  child  varies  from  an  in- 
ability to  pronounce  numerous  consonants,  to  unintelligible  speech 
of  a  babbling  or  of  a  laUing  type.  There  is  frequently  a  misappli- 
cation of  words,  inability  to  recall  the  appropriate  word,  imperfect 
arrangement  of  sentences  or  slurred,  hesitating  and  indistinct 
speech.  Speech  usually  develops  late  in  mental  defectives.  Idiots 
commonly  have  no  speech  at  all.  Imbeciles  are  able  to  understand 
and  speak  short  sentences,  but  never  acquire  a  large  vocabulary  or 
perfect  articulation.  Morons  show  fewer  imperfections  of  articu- 
lation and  a  more  extensive  vocabulary,  but  are  usually  incapable 
of  constructing  or  understanding  a  complicated  sentence.  It  is 
recognized  by  authorities  on  feeble-mindedness  that  there  is  a  dis- 
tinct relationship  between  the  capacity  for  speech  and  the  degree  of 
mental  defect.  In  fact,  an  early  classification  of  mental  defectives 
used  the  degree  of  speech  development  as  a  criterion  for  the  amount 
of  defect,  those  without  speech  being  classed  as  idiots.  This  is  un- 
wise, however,  as  the  absence  of  speech  may  be  due  to  some  very 
different  cause.  In  view  of  our  modern  knowledge  of  aphasia  and 
similar  disorders,  it  would  be  manifestly  incorrect  to  class  as  idiots 
all  children  in  whom  speech  is  absent. 

Echolalia 

Echolalia  is  a  peculiar  form  of  verbal  response  seen  in  the  lower 
grades  of  mental  defect.  In  can  be  classed  as  a  speech  defect  only 
because  the  subject  does  utter  words.  It  has  been  explained  as  a 
symptom  of  an  organic  condition  in  which  the  lower  nervous  centers 
are  abnormally  permeable  to  the  nervous  discharge  with  the  result 
that  the  incoming  excitation  is  immediately  transformed  into  an 
outgoing  impulse  without  traversing  the  appropriate  higher  speech 
areas.  Consequently,  the  child  merely  echoes  words  or  phrases  with 
no  understanding  of  their  meaning.  Partial  echolalia  may  appear 
and  persist  as  an  infantile  speech  habit  in  children  who  are  not 
abnormal. 

*' Sluggishness" 

The  normal  speech  of  children  is  fairly  energetic  and  smooth. 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH     15 

Excessively  slow  and  hesitant  speech  is  usually  associated  with 
physical  disabilities.  The  speech  of  many  feeble-minded  children, 
especially  cretins,  is  frequently  sluggish  because  of  their  general 
lack  of  energy  and  vitality,  resulting  in  slow  reactions.  In  normal 
children  such  sluggishness  may  be  due  to  exhaustion  after  ilkiess, 
anaemia,  or  interference  with  proper  respiration,  because  of  the 
presence  of  adenoids  and  hypertrophied  tonsils.  Sluggish  speech  is 
also  often  manifest  in  nervous  disorders  or  psychotic  conditions 
such  as  dementia  praecox,  depressed  states  and  the  hysterias, 
''Cluttering" 

In  contrast  to  ''sluggishness"  is  the  condition  known  as  ''clut- 
tering," when  there  is  excessive  rapidity  of  utterance.  The  "clut- 
terer"  is  often  a  child  of  superior  mentality  whose  thoughts  run 
ahead  of  his  ability  to  express  them,  with  resulting  faulty  articula- 
tion because  of  the  inability  of  the  motor  mechanism  to  keep  pace 
with  the  speech  impulse.  In  highly  neurotic  children  who  show  this 
speech  condition,  the  over-productiveness  is  associated  with  respira- 
tory difSculties,  defects  of  vocalization  such  as  shrillness,  monotony, 
■etc,  and  intense  mental  excitement.  The  treatment  for  these  de- 
fects must  be  directed  toward  improving  the  general  nervous  condi- 
tion of  the  child  and  training  him  in  good  speech  habits. 
stuttering 

Stuttering  is  difficult,  unrhythmical  speech  characterized  by  spas- 
modic contractions  of  the  entire  oral  mechanism  and  incoordination 
•of  the  respiratory,  laryngeal,  and  oral  muscles.  The  nerve  centers 
are  often  so  innervated  that  the  individual  is  unable  to  phonate 
■either  momentarily  or  for  a  longer  period.  This  condition  may 
persist  for  several  weeks.  The  accumulated  energy  which  is  not 
directed  into  the  appropriate  centers  in  the  oral  mechanism  over- 
flows into  centers  controlling  the  muscles  of  eyes,  face,  chest  and 
^rms. 

Stuttering  seems  to  be  dependent  on  a  congenital  weakness  of  the 
speech  organs ;  some  authorities  believe  that  it  may  recur  in  several 
individuals  in  successive  generations  of  the  same  family,  A  great 
many  very  young  normal  children  show  slight  signs  of  stuttering, 
Iiowever,  when  they  have  not  yet  acquired  sufficient  control  of  the 
speech  process  to  make  it  automatic.  This  is  especially  the  case  in 
ichildren  of  neurotic  and  emotionally  unstable  type.    Indeed  there 


16  IOWA  STUDIES  IN  CHILD  WELFARE 

is  an  intimate  connection  between  stuttering  and  strong  emotion. 
Adults  who  have  been  cured  of  stuttering  will  suffer  a  relapse  under 
great  excitement  and  children  will  often  manifest  the  first  signs 
after  a  shock  or  fright.  Any  great  physical  strain,  a  severe  illness, 
chorea,  or  pubescent  changes  will  precipitate  an  attack  in  neurotic 
subjects  who  are  predisposed  to  the  disorder. 

In  addition  to  being  handicapped  by  nervous  instability,  or  per- 
haps because  of  this  defect,  the  stutterer  generally  suffers  from  a 
morbid  mental  state.  He  is  typically  introspective,  hypersensitive, 
apprehensive,  and  seclusive.  His  speech  disturbance  makes  him 
socially  ill-adjusted  and  his  unsocial  tendencies  serve  to  isolate  him 
still  further.  Before  speech  and  respiration  exercises  can  be  ex- 
pected to  cause  much  improvement,  the  stutterer's  whole  mental 
attitude  must  be  changed,  his  attention  directed  to  external  inter- 
ests, and  his  social  personality  developed.  General  physical  up- 
building is  of  fundamental  importance  in  the  correction  of  stutter- 
ing, as  of  all  speech  defects  of  nervous  origin,  and  usually  brings  an 
immediate  improvement  in  the  condition. 

C.    Defective  Vocalization 

Under  the  head  of  defects  of  vocalization  are  classed  complete 
absence  of  speech  and  certain  departures  from  the  quality  of  the 
normal  voice. 

Absence  of  power  to  speah  results  in  some  eases  from  lesions,  dis- 
ease, or  congenital  defects  producing  paralysis  of  the  parts  of  the 
peripheral  speech  mechanism — lips,  tongue,  larynx,  and  palate.  A 
paralysis  of  a  certain  part  produces  a  characteristic  change  in  the 
vocal  quality,  due  to  the  change  in  the  aperture  through  which  the 
air  must  pass,  or  to  non-functioning  of  some  of  the  vocal  cords. 
Complete  absence  of  speech  results  also  from  lesions  in  the  central 
areas — ^motor,  imaginal,  associational — or  in  their  projection  fibres. 
The  phenomena  of  aphasia  resulting  from  such  lesions  have  been 
too  frequently  described  to  bear  repetition  here.  Absence  of  speech 
also  occurs  as  a  result  of  functional  involvement  of  any  part  of 
these  centers  or  of  their  pathways. 

Mutism  is  frequently  consequent  upon  congenital  or  acquired 
deafness,  since  the  child  is  not  stimulated  to  imitate  sounds  which 
the  hearing  child  experiences.  For  the  deaf  child  special  devices 
must  be  used  in  order  that  visual,  tactual,  and  kinaesthatic  imagery 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH     17 

may  serve  as  guides  and  awaken  speech  in  a  child  bom  deaf  or  pre- 
serve it  from  deterioration  in  one  who  has  become  deaf. 

Refusal  to  speak  is  a  psychopathic  manifestation  frequently  mis- 
taken for  real  inability  to  vocalize. 

A  number  of  other  changes  in  quality,  not  due  primarily  to 
paralysis,  are  discussed  below. 

Nasality  is  frequently  due  to  changes  in  the  air  passages  result- 
ing from  cleft  palate  or  hair  lip.  Owing  to  the  absence  or  shortness 
of  the  velum,  the  child  is  unable  to  shut  off  the  opening  into  the" 
naso-pharynx  during  the  emission  of  oral  consonants,  with  a  result- 
ing unpleasant  quality  in  these  tones.  Nasality  may  also  be  due  to 
deflection  of  the  nasal  septum  which  interferes  with  the  reinforce- 
ment of  tone  by  the  resonance  chambers  of  the  head.  So,  also, 
adenoid  growths  blocking  the  naso-pharynx  interfere  with  the  nasal 
resonance. 

Nasality  also  results  from  certain  forms  of  laryngeal  and  palatal 
paralysis.  Frequently  it  is  merely  the  result  of  habitual  constric- 
tion of  the  throat  and  posterior  nasal  passages. 

Monotony.  Absence  of  proper  inflection  and  of  pitch  changes 
characteristic  of  the  normal  voice  frequently  occurs  as  a  result  of 
cleft  palate,  adenoids,  deflected  septum,  or  obstruction  of  the  pas- 
sages by  diseased  tissue.  Peripheral  or  central  defects  in  the 
nervous  mechanism  are  often  responsible  for  the  monotonous  tones 
frequently  observed  in  the  speech  of  persons  suffering  from  nervous 
and  mental  diseases. 

Hoarseness;  harshness.  Chronic  pharyngitis,  or  "clergyman's 
sore  throat",  is  one  of  the  most  common  types  of  huskiness  or 
hoarseness.  The  muscles  of  the  pharynx  become  constricted  in 
movement,  inflamed  and  uncomfortable,  modifying  the  vocal 
resonance.  This  may  be  due  to  extreme  fatigue,  long  continued  use 
of  the  voice  under  abnormal  conditions,  or  to  misuse  of  the  voice. 
Other  defects  of  the  vocal  cords  may  be  responsible.  Recurrent  or 
persistent  hoarseness  is  an  indication  of  abnormal  conditions  neces- 
sitating medical  examination. 

"Throatiness."  A  peculiar  quality  of  the  voice  known  as 
"throatiness"  sometimes  results  from  an  elongated  or  hyper- 
trophied  uvula,  which  interferes  with  the  lingual  sounds.  Hyper- 
trophied  tonsils  or  a  thickened  tongue  will  partly  fill  the  resonance 
chamber,  altering  the  timbre  of  the  voice  to  produce  this  effect.    A 


18  IOWA  STUDIES  TN  CHILD  WELFARE 

habit  of  elevating  the  posterior  portion  of  the  tongue  and  pressing 
the  soft  palate  against  the  posterior  wall  of  the  pharynx  is  another 
frequent  cause  of  this  unpleasant  vocal  quality. 

Non-sibilant  voice.  When  no  deformity  or  physical  defect  exists 
in  the  speech  resonance  chamberf!,  a  non-sibilant  or  high-pitched 
voice  of  unpleasing  quality  is  frequently  due  to  shallow  breathing 
and  respiratory  disturbances.  The  attempt  to  speak  with  only 
residual  air  in  the  lungs,  rather  than  upon  a  fresh  inspiration,  will 
produce  such  speech.  It  is  also  found  that  affections  of  the  thymus 
and  thyroid  glands  are  associated  with  this  type  of  speech.  Atrophy, 
defect,  or  local  inflammation  of  the  vocal  cords  is  capable  of  pro- 
ducing high  pitched  tones,  lacking  in  richness  and  without  the  over- 
tones wTiich  are  found  in  the  voice  of  lower  pitch. 

It  appears  from  this  analysis  that  some  speech  defects  are  due  to 
organic  conditions  such  as  paralysis,  which  are  not  subject  to  cor- 
rection. For  children  with  other  organic  defects  such  as  malforma- 
tion and  obstruction  in  the  air  passages,  the  prognosis  is  favorable, 
provided  these  conditions  are  corrected.  Children  suffering- from 
functional  conditions  which  may  be  classed  as  minor  speech  inaccu- 
racies due  to  incorrect  habits,  will  respond  to  treatment  and  train- 
ing in  a  most  satisfactory  manner.  A  program  for  successful  work 
in  the  correction  of  speech  defects  must  include:  (1)  correction  of 
physical  defects  and  general  physical  upbuilding;  (2)  establishment 
of  proper  mental  attitude:  (3)  speech  training.  As  type  studies  of 
this  mode  of  procedure  there  follow  two  cases. 

IV.     A  REPORT  ON  TWO  TYPE  CASES 

Type  Case  A 

In  September,  1918,  a  ten  year  old  boy  who  had  been  a  stutterer 
since  the  age  of  three  years,  was  brought  to  the  Iowa  Child  Welfare 
Research  Station  for  examination.  As  he  was  found  to  be  in  need 
of  medical  treatment,  he  was  kept  in  his  home  in  a  small  town  in 
Towa  for  this  purpose  during  four  months,  and  then  brought  back 
to  Iowa  City  for  six  months'  observation  and  training. 

By  means  of  numerous  interviews,  letters,  and  conversations  with 
the  boy  himself,  the  staff  of  the  Station  gradually  gained  an  insight 
into  the  child's  background  and  personality. 

The  boy  had  been  physically  feeble  from  infancy.     While  the 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH     19 

family  history  showed  no  grave  abnormalities,  it  did  reveal  a  neuro- 
pathic strain.  In  a  maternal  uncle  and  in  the  boy's  only  sister,  a 
girl  nineteen  months  his  senior,  appeared  the  same  tendency  to 
stuttering  that  handicapped  the  boy.  The  boy 's  mother,  though  an 
intelligent  woman,  who  had  taught  school  for  a  number  of  years 
before  her  marriage,  was  of  a  nervous  and  introspective  type. 
John's  habitual  emotional  tone  was  low;  he  did  not  care  to  play 
with  other  hoys  of  his  age  with  whom  he  could  not  compete  on  ac- 
count of  his  lack  of  strength,  and  he  was  extremely  sensitive  to 
criticism  and  very  much  aware  of  his  disabilities. 

Anthropometric  measurements  showed  that  John  did  not  vary- 
greatly  from  the  average  for  his  age ;  the  height,  weight  and  breath- 
ing capacity  were  slightly  below  the  normal.  The  boy  appeared 
malnourished  and  was  very  easily  fatigued. 

Although  the  tonsils  and  adenoids  had  been  removed  (and  cir- 
cumcision performed  after  the  boy's  preliminary  examination  at 
the  Station),  it  appeared  from  the  report  of  the  University  Hospital 
that  his  general  condition  was  still  poor.  He  showed  the  effects  of 
rickets  in  infancy.  At  the  time  of  examination,  there  was  present 
a  latent  tetany  and  chronic  indigestion,  which  seemed  to  be  con- 
nected partly  with  his  habits  of  eating  large  amounts  of  a  poorly 
balanced  diet,  and  partly  with  his  poor  mastication  as  a  result  of 
dental  deformities.  The  University  dental  clinic  found  that  he 
suffered  from  malocclusion  and  marked  protrusion  of  the  upper 
teeth,  both  upper  and  lower  arches  being  narrower  than  is  normally 
the  ease. 

This  dental  condition  contributed  to  his  speech  defect.  Nasal 
obstruction  had  been  removed,  but  the  boy  still  had  poor  control  of 
the  breathing  apparatus;  there  was  marked  spasmophilia  of  the 
respiratory  and  facial  muscles  during  speech,  with  some  involve- 
ment of  the  frontal  muscles  and  protrusion  of  the  eyeball.  His 
specific  stuttering  difficulties  were  with  the  production  of  the  vowels 
a,  0,  u,  in  initial  positions  and  with  certain  consonants  at  the  begin- 
ning of  words;  stuttering  took  place  upon  practically  every  con- 
sonant when  used  as  an  initial  letter.  During  protracted  stuttering 
the  hypertonicity  of  the  speech  mechanism  communicated  itself  to 
the  muscles  of  the  arms,  head,  and  trunk. 

The  speech  defect  was  associated  with  much  forgetfulness  and 
frequent  mental  confusion,  resulting  in  a  blocking  of  the  speech 


20  IOWA  STUDIES  IN  CHILD  WELFARE 

centers  and  peripheral  speech  mechanism  under  excitement.  Under 
favorable  circumstances,  a  mental  rating  was  obtained  which 
showed  John  to  be  of  average  intelligence  with  a  Terman  I,  Q.  of 
103.  Other  psychological  tests,  undertaken  because  of  their  pos- 
sible bearing  on  the  speech  problem,  revealed  normal  audition  but 
an  exceedingly  poor  functioning  of  imagery. 

It  seemed  evident  that  the  first  step  in  overcoming  the  speech 
difficulty  was  to  improve  the  boy's  general  condition  and  provide  a 
better  environment.  Arrangements  were  accordingly  made  to  have 
him  board  in  Iowa  City  in  a  family  where  there  were  two  active 
boys  whose  companionship  would  prove  beneficial.  A  schedule  was 
made  for  each  hour  of  the  day  in  order  that  the  boy  might  acquire 
better  habits  of  living.  Diet  was  carefully  regulated,  proper  amount 
of  rest  insured,  and  healthful  outdoor  exercise  encouraged.  A  rec- 
ord of  weight  was  kept  and  the  appended  weight  curve  plotted. 

Orthodontic  work  was  undertaken  at  the  University  Clinic  to 
correct  the  malocclusion.  John  was  not  allowed  to  attend  afternoon 
school  but  rested  for  a  period  after  dinner  and  was  then  given 
special  speech  training.  This  included  tongue  and  mouth  gym- 
nastics, breathing  exercises,  harmonic  gymnastics,  drill  on  difficult 
sounds,  together  with  general  work  to  improve  speech  melody  and 
inflection  and  to  increase  range  and  volume  of  tone.  A  special 
effort  was  made  through  dramatization,  playing  store  and  using  the 
telephone,  to  establish  self-confidence.  Phonographic  records  were 
made  of  the  boy's  speech  twice  a  month  so  that  the  gradual  elimina- 
tion of  stuttering  could  be  studied. 

As  part  of  John's  difficulty  in  speech  seemed  to  be  connected  with 
his  introverted  habit  of  mind,  an  attempt  was  made  to  overcome  his 
morbid  tendencies  by  having  him  come  to  the  laboratory  regularly 
to  talk  over  his  problems  and  acquire  a  more  wholesome  attitude 
toward  life. 

It  was  understood  from  the  beginning  that  the  complete  rehabili- 
tation of  this  boy  would  require  a  very  long  period  of  close  super- 
vision in  a  controlled  environment.  Nevertheless,  the  corrective 
measures  undertaken  for  even  these  few  months,  produced  a  meas- 
ureable  result  as  is  shown  by  the  appended  curves  and  photographs 
of  his  progress  in  overcoming  speech  difficulties,  increasing  his 
weight,  and  obtaining  more  normal  occlusion. 

The  accompanying  weight  curve  shows  in  an  interesting  way  the 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH    21 


lbs. 

61 
30 
7S 
76 
77 
76 
7S 
74 
73 
72. 


7/ 


,, 

..  — .. 

Two 

sessions  of  behoof. 

— —  (?/?«  School  ■Sassion , 

Forqoi  to  Drink  Milk , 

£xi»nsivt  Oarfal  Treatment, 

—•'■—  After  refurn   home , when 
taking   Cod  Liver  Oil, 

/ 

s 

f 

'"*^, 

/ 

b^ 

, 

,x> 

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•"-c"' 

1 

\ 

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C 

1 

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- 

J 

\: 

P 

-0 

cy' 

10      M     ZO      to      10     SO      10     20     30      IQ      HO    30     10 
Jan.        Feb.  Inarch  April  M^ij 

Weight-eurve — John 


£0    30      10 

June 


20    30    /o    go  JO 
Jul  If 


■effect  of  the  prevention  of  excessive  fatigue,  of  special  additions  to 
diet,  of  dietary  disturbances,  and  of  irritability  due  to  dental  treat- 
ment— each  such  disturbance  resulting  in  a  loss  of  weight.  As  a 
result  of  improved  assimilation  of  food  consequent  upon  better  liv- 
ing conditions  and  dental  care,  growth  in  weight  was  considerably 
stimulated. 

The  record  of  phonographic  speech  errors  shows  similar  fluctua- 
tions. In  general,  there  was  a  reduction  of  stuttering  errors  from 
fifteen  in  the  first  record  to  none  in  the  record  taken  at  the  end  of 
four  months.  When  the  dental  appliance  was  first  placed  in  the 
mouth,  the  errors  again  increased,  but  they  were  practically  elim- 
inated after  six  months'  treatment. 

The  great  improvement  in  the  shape  of  the  dental  arches  is 
shown  by  the  appended  photographs  of  the  casts  made  of  John's 
teeth  before  and  after  treatment,  including  a  period  of  ten  months. 

In  view  of  his  generally  improved  condition,  it  was  thought  not 
inadvisable  for  him  to  return  home  provided  occasional  visits  were 
made  for  further  orthodontic  work  and  re-examination  at  the  Child 
Welfare  Station.     Up  to  the  present  time  there  appears  to  have 


22 


IOWA  STUDIES  IN  CHILD  WELFARE 


o  10 


AHend/ng  one  Sess/ori  o-f  School , 

Frequenf  Denial    Treafn)enf 

leodinq  to  Fixture,  of  Appliance^, 
Child  Taking-  Cod  Liver  OH. 

(Sehf  homa  June.  lOth.) 

K 

\ 

\j 

s 

\ 

\ 

\ 

\ 

1 

/ 

\ 

\ 

\ 

^ 

S 

r/ 

\ 

Si^ 

y^ 

,:j 

0    -e 

0     J( 

0      /(. 

■)    4 

0     ,?. 

0    /< 

7      £ 

0    -3 

0    n 

■>     £ 

0    Ji 

>       A 

>    -e 

0    3 

O     / 

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O    J 

o    / 

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c  -Jn 

Speech-errors — John 

been  continued  gain  in  weight,  generally  improved  speech  (though 
occasional  relapses  into  bad  speech  habits  have  occurred),  and  a 
real  improvement  in  social  reactions. 


Weight  op  John 


Jan.  24,  1919 
Feb.  8th 
Feb.  25th 
March  8th 
March  21st 
April  8th 
April  15th 
April  24th 
May  14th 
May  29th 
June  10th 
June  24th 
July  9th 
July  25th 


7114  lbs. 

72% 
727/8 

771/2 
77 

77% 
771/2 
78 

75% 
733^ 

75% 
77 

761/2 
77% 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH    23 


Phonographic  Speech  Record  of  John 

January  10th  to  August  8th,  1919 

errors 

January  10th 

15 

January  24th 

12 

February  7th 

12 

February  21st 

7 

March  7th 

4 

March  20th 

3 

April  15th 

0 

April  26th 

2 

May  16th 

7 

May  30th 

10 

July  25th 

0 

August  8th 

2 

The  picture  shown  below  in  the  accompanying  cut  represents 
the  degree  of  malocclusion  existing  before  John  began  orthodontic 
treatment  at  the  Dental  Infirmary  in  May,  1919.     The  picture  at 


the  right  shows  the  improved  occlusion  ten  months  later  (March, 
1920),  the  following  results  being  evident:  first,  the  widening  of 
the  mouth  space  (%  inch  in  the  canine  region  and  approximately 
%  inch  in  the  premolar  region)  ;  second,  the  correction  of  the  in- 
ward slant  of  the  premolars  to  normal  position ;  third,  the  improved 
position  of  the  incisors  of  both  upper  and  lower  arches ;  fourth,  the 
development  of  the  premaxillary  bone.  Since  these  corrections 
have  been  made,  good  mastication  of  food  has  been  secured,  proper 
breathing  habits  are  being  established,  and  physical  growth  has 
been  accelerated. 


24  IOWA  STUDIES  IN  CHILD  WELFARE 

Type  Case  B 

In  January,  1918,  a  member  of  the  psychological  department  of 
the  University  on  a  trip  to  a  nearby  town  examined  a  girl  of  twelve 
years,  who  was  suffering  from  stuttering.  He  reported  her  to  be  of 
about  average  intelligence,  but  very  nervous.  In  October,  1918,  she 
was  brought  to  the  Research  Station  for  further  examination. 

The  family  history  as  reported  by  the  parents  revealed  a  tendency 
to  "nervousness"  in  the  mother's  family  and  another  case  of  stut- 
tering— the  mother's  brother.  The  girl  herself  had  begun  stutter- 
ing upon  entering  school  and  at  the  beginning  of  each  school  year 
had  shown  for  a  time  a  slight  speech  disturbance.  During  the  fall 
of  1918,  this  recurring  attack  had  become  so  severe  as  to  impress 
the  parents  with  the  necessity  of  seeking  help  from  the  Research 
Station. 

The  girl  had  had  no  very  severe  diseases  and  appeared  to  be  well 
developed,  though  slightly  underweight.  The  physical  examination 
at  the  University  Hospital  revealed  nothing  of  consequence  except 
enlarged  tonsils.  Her  posture  was,  however,  poor,  her  chest  was 
noticeably  flat,  and  her  behavior  showed  signs  of  excessive  nervous- 
ness, being  characterized  by  jerky,  awkward  movements. 

The  child  was  obviously  in  the  prepubescent  period,  though  the 
parents  did  not  seem  to  be  aware  of  this  fact.  They  had,  however, 
consulted  the  family  physician  in  regard  to  this  nervousness  and 
had  been  specially  warned  against  over-stimulation. 

Alice's  emotional  condition  was  apparent  in  her  facial  expres- 
sion, which  indicated  sulkiness,  stubbornness,  and  pouting.  Further 
acquaintance  showed  her  to  be  a  highly  strung,  over-stimulated  girl 
of  nervous  temperament,  easily  excited,  lacking  in  control  and 
decidedly  willful. 

The  mental  examination  at  the  Research  Station  confirmed  the 
earlier  diagnosis  of  average  intelligence.  With  a  chronological  age 
of  thirteen  years,  seven  months,  and  a  Terman  mental  age  of  four- 
teen years,  eight  months,  her  I.  Q.  was  108  No  defects  in  imagery 
were  discovered,  although  there  apparently  was  a  deficiency  of  this 
sort,  since  Alice  was  unable  to  reproduce  short  stories  or  to  recount 
incidents  from  her  daily  life  and  showed,  moreover,  an  intense  dis- 
like for  any  exercise  requiring  reproduction  from  imagination.  She 
had  also  all  the  inhibitions  and  dread  of  failure  common  to  habitual 
stutterers. 


PEELIMINARY  STUDY  IN  CORRECTIVE  SPEECH    25 

The  speech  examination  indicated  a  functional  disturbance  with 
excessive  rapidity  and  lack  of  rhythm.  During  speech  there  was 
interference  with  normal  respiration,  the  hypertonicity  being  fre- 
quently communicated  to  the  muscles  of  the  eye,  face,  and  dia- 
phragm. There  were  frequent  interruptions  in  the  middle  of  a 
word  or  phrase  with  attempts  to  speak  while  an  inspiration  was 
taking  place.  Certain  consonants  in  initial  position  were  pro- 
nounced with  difficulty  and  then  in  an  explosive  manner,  indicating 
incoordination  of  the  respiratory  and  vocal  muscles.  All  these 
difficulties  became  less  noticeable  when  the  child  was  required  to 
speak  slowly. 

From  these  examinations  it  was  apparent  that  this  interrelated 
group  of  disturbances  could  be  overcome  only  by  means  of  general 
physical  upbuilding,  combined  with  specific  speech  training.  Ac- 
cordingly, Alice  was  brought  to  Iowa  City  and  placed  in  the  home 
of  a  woman  with  some  training  in  the  care  of  special  cases.  Her 
school  program,  rest,  recreation,  and  diet  were  controlled  by  means 
of  a  schedule  for  every  hour  of  the  day.  Regular  speech  training 
was  undertaken  for  the  purpose  of  establishing  normal  habits  of 
breath  control,  of  insuring  proper  formation  of  vowels  and  con- 
sonants, and  of  securing  a  transfer  of  attention  from  habitual 
faults  to  distinct  utterance. 


lbs. 

aA 

C/?e  S&ss/on  o^ School 

Cmot/ona/   Disturbance, 

97 

J 

) 

r 

\ 
\ 

J 

/ 

1 

' 

3S 

A 

r- 

-J 

1 

\ 

J 

03 

^ 

J 

V 

P^ 

^ 

O/ 

y 

y 

^ 

/ 

AQ 

cr 

y^— 



to     ZO    JO      10      £0    30      /O      eO    so      /O      £0    30     'O      £0  -^O      /o     ^O    30 

Jan.  Feb.  March         A  on' I  Maij  June 

Weight-curve — AKce 


26 


IOWA  STUDIES  IN  CHILD  WELFARE 


The  effect  of  five  months  in  a  controlled  environment  is  shown  in 
the  accompanying  weight  chart.  In  general,  there  is  an  increase  in 
weight,  although  there  are  three  distinct  drops  in  the  curve,  each 
corresponding  to  an  occasion  of  marked  emotion  disturbance. 


16 
/Z 

^  a 

V 


Shows  Norma/  Proqress  in 

•Speech    Improvame-nt, 

Shows  Disturbance^  in  Spe&ch 

Due^  to  rmof/ona/  Chancre, 

\ 

\ 

k 

v 

A 

\ 

\ 

\ 

\ 

^ 

y^ 

N 

/ 

r^- 

"-.. 

''•^3 

/O      ZO     JO      /O      ZO     -50      /O      ZO    30      /O     40    ^O     /O      £0    .30 

Jan.         Feb.  March  April  Mat^ 

Speech-errors — Alice 


The  result  of  speech  training  during  these  five  months  is  shown 
in  the  appended  curve  of  errors  plotted  from  the  phonographic 
test  records  made  by  the  child  at  frequent  intervals  during  the 
elimination  of  stuttering.  This  curve  shows  a  gradual  reduction  of 
errors,  but  with  lapses  in  speech  control  similar  to  the  loss  in  weight 
and  coincident  with  the  same  occasions  of  emotional  disturbance. 

The  distinct  improvement  under  controlled  conditions  was  so 
evident  that  the  parents  took  steps  to  place  this  girl  in  a  boarding 
school  where  she  might  continue  her  speech  training  and  acquire 
emotional  control  under  close  supervision. 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH    27 
Weight  of  Alice 


January  7th 

891/2  lbs. 

February  14th 

9214 

March  15th 

933/4 

March  25th 

96 

April  4th 

931/2 

April  14th 

957/8 

April  25th 

951/4 

May  6th 

97% 

May  13th 

98 

May  20th 

99 

May  27th 

97 

June  4th 

97 

June  11th 

981/4 

Phonographic  Speech  Record  op  Alice 

January  10th  to  May  30th,  1919 

errors 

January  10th 

14 

January  24th 

9 

February  7th 

10 

February  22nd 

0 

March  7th 

2 

March  21st 

0 

April  15th 

0 

April  24th 

2 

May  17th 

0 

'  May  30th 

0 

V.     MATERIALS  FOR  SPEECH  EXAMINATION 
In  checking  the  speech  errors  of  individual  children,  the  examiner 
uses  the  accompanying  word  lists  and  test  sentences  containing  the 
consonants  in  initial,  middle  and  final  position;  sentences  contain- 
ing the  five  vowels,  long  and  short ;  the  most  common  of  the  difficult 

consonant  combinations ;  and  the  diphthongs uy,  -oy,  -ow,  -ew. 

The  particular  sounds  are  arranged  in  test  sentences  which  are 
given  to  the  child  to  be  read,  while  the  examiner  checks  the  cor- 
responding word  list,  underlining  the  character  which  gives  diffi- 
culty or  which  is  inaccurately  articulated.  The  Roman  numerals, 
I,  II,  III  and  IV  on  the  examiner's  page  refer  to  error  types,  such 


28  IOWA  STUDIES  IN  CHILD  WELFARE 

as  initial,  middle  or  final  consonant,  long  or  short  vowel,  difficult 
consonant  combination,  or  diphthong.  The  Arabic  numerals  1  to 
46  correspond  to  the  number  of  the  sentence  in  which  listed  sound 
appears. 

The  date  of  the  first  examination  is  noted,  the  words  missed  being 
underlined  on  that  date.  As  the  errors  are  progressively  eliminated, 
the  columns  at  the  right  are  to  be  filled  in  to  show  date  of  first 
elimination,  reappearance  of  difficulty,  and  approximate  date  of 
final  elimination  for  each  sound. 

INDrVIDUAL  SPEECH  EECOED 

Date X  accurate ;  o  inaccurate 

Name 

Address 

I.     Consonants  in  initial,  middle  and  final  position 

ELIM.        EEAP.        FINAL    ELIM. 

1.  bear,  nibble,  stub 

2.  cook,  baked,  cake 

3.  Dan,  conduct,  good 

4.  flying,  offer,  off 

5.  goose,  again,  egg 

6.  hopes,  harm,  hounds 

7.  jockey,  injured,  hedge 

8.  key,  broken,  take 

9.  let,  dollar,  will 

10.  must,  Emma,  some 

11.  Nan,  dinner,  fountain 

12.  pack,  apples,  deep 

13.  queen,  toque 

14.  read,  rural,  fruit,  fire 

15.  sit,  listen,  us 

16.  trembled,  tattered,  blast 

17.  very,  velvet,  have 

18.  will,  tower,  now 

19.  exact,  inexpert,  fox 

20.  yellow,  merry 

21.  zeal,  prisoner,  cause 

22.  children,  peaches,  lunch 
'  23.  shy,  dashing,  marsh 

24.  wheel,  pleasure 

25.  that,  father,  with 

26.  thought,  author,  Smith 


PRELIMINARY  STUDY  IN  CORRECTIVR  SI»ERCH    29 
II.    Vowels  (1),  (long) 

27.  cat,  cake,  bite 

28.  «se,  boat 

Vowels  (2),  (short) 

29.  kit,  mend,  bat 

30.  bond,  ■up 

III.  Difficult  consonant  combinations 

31.  Dwight,  twirl,  athwart 

32.  great,  crowd,  praise 

33.  fright,  brave,  track 

34.  drove,  through,  spruce 

35.  mild,  melt 

36.  supple,  able,  kettle 

37.  spear,  struck,  split 

38.  squire,  escape,  sword 

39.  shrink,  strike 

40.  dusk,  smooth,  snow 

41.  place,  flooded,  gloom 

42.  clouds,  blend,  sloping 

43.  gathering,  strength,  brinfc 

44.  stands,  scrub 

IV.  Diphthongs 

45.  Guy,  toy 

46.  few,  cows 

TEST  SENTENCES  FOE  INDIVIDUAL  SPEECH  RECOED 

1.  The  bear  nibbled  at  the  stub. 

2.  The  cook  baked  a  cake. 

3.  Dan's  conduct  was  good, 

4.  He  went  flying  off  after  the  offer. 

5.  The  goose  again  laid  a  golden  egg. 

6.  He  hopes  not  to  harm  the  hounds. 

7.  The  jockey  was  injured  in  taking  the  hedge. 

8.  Take  the  broken  key. 

9.  Let  me  borrow  a  dollar  and  I  will  repay  you. 

10.  He  must  give  Emma  some  candy. 

11.  Nan  ate  her  dinner  by  the  fountain. 

12.  Pack  the  apples  in  a  deep  box. 

13.  The  queen  wore  a  brown  toque. 

14.  I  read  that  the  fire  in  rural  places  spoiled  much  fruit. 

15.  Sit  and  listen  with  us. 

16.  He  trembled  in  his  tattered  garments  at  the  blast. 

17.  That  is  very  like  the  velvet  which  I  have. 


30  IOWA  STUDIES  IN  CHILD  WELFARE 

18.  Will  he  mount  the  tower  now? 

19.  To  be  exact,  he  is  an  inexpert  fox  hunter. 

20.  The  yellow  glow  of  the  Yule  log  and  merry  laughter  attracted  them. 

21.  The  zeal  of  the  prisoner  was  used  in  a  poor  cause. 

22.  The  children  shared  their  peaches  at  lunch. 

23.  The  shy  creature  went  dashing  through  the  marsh. 

24.  The  wheel  gave  him  pleasure. 

25.  I  think  that  your  father  went  with  him. 

26.  I  thought  the  author's  name  was  Smith. 

27.  You  may  eat  the  cake  if  you  will  give  me  a  bite. 

28.  Shall  you  use  the  boat? 

29.  Kit  was  unable  to  mend  the  bat. 

30.  The  bond  was  locked  up  in  the  safe. 

31.  Dwight  twirled  the  stick  athwart  the  path. 

32.  The  great  crowd  praised  the  speaker. 

33.  The  frightened  brave  fled  from  the  track. 

34.  They  drove  through  forests  of  spruce. 

35.  This  mild  weather  melts  the  snow. 

36.  With  supple  movements  he  was  able  to  lift  the  iron  kettle. 

37.  As  the  spear  struck,  the  armour  split  in  twain. 

38.  The  squire  escaped  the  sword. 

39.  They  shrink  from  declaring  a  strike. 

40.  At  dusk  the  fence  was  smoothly  capped  with  snow. 

41.  The  place  was  flooded  with  gloom. 

42.  The  clouds  blend  with  the  sloping  horizon. 

43.  Gathering  strength,  he  drew  himself  to  the  brink. 

44.  There  stands  a  scrub  pine. 

45.  Guy  has  a  new  toy. 

46.  They  keep  a  few  cows. 

VI.  MATERIALS  FOR  PHONOGRAPHIC  TEST  RECORDS 

Part  of  the  materials  used  in  testing  John  is  here  assembled  as 
samples  of  the  method  of  procedure  in  speech  cases  of  his  type. 
The  tests  were  usually  given  at  two  weeks  intervals.  Every  other 
test  was  generally  a  re-test  on  the  material  of  the  preceding  test  to 
note  the  effect  of  specific  drill  on  sounds  which  the  test  had  shown 
were  inadequately  produced.  This  drill  was  never  on  the  test  mate- 
rial itself. 

TEST  SET  3 

(1)  Words  showing  range  of  tone. 

(2)  Words  showing  volume  of  tone. 

(3)  Sentences  arranged  so  as  to  contain  sounds  of  vowels,  and  consonants 
used  in  initial  position,  the  numeral  indicating  the  number  of  times  each 


PEELIMINARY  STUDY  IN  CORRECTIVE  SPEECH     31 

was  used,  as  follows:  a(2),  b(5),  d(3),  e(l),  f(2),  g(l),  h(3),  i(l), 
j(l),  k(5),  1(2),  m(l),  11(1),  p(7),  qu(l),  r(l),  s(2),  t(6),  th(voiceles8, 
1),  th(voiced,  10),  v(2),  w(2)— (oo),  wh(l),  y(l). 

1.  Patty  bought  more  white  wafers. 

2.  A  few  fine  villages. 

3.  The  tall  timbers  cover  two  lots. 

4.  Come  quickly,  the  cows  are  in  the  corn. 

5.  Verily,  he  has  saved  enough  to  prevent  poverty. 

6.  I  think  that  will  do. 

7.  Does  Zeus  answer  the  people  thus? 

8.  Peter  paid  the  price  gladly. 

9.  Eing  the  library  bell. 

10.  George  can  bring  the  bugler's  horn. 

11.  She  tried  to  drill  nine  youths. 

12.  The  ship  bore  treasure. 

(4)     Short  selection  containing  a,  e,  i,  o,  oo  vowel  sounds  in  initial  position. 
As:— 

"Have  you  seen  an  apple  orchard,  in  the  spring,  in  the  spring?  An 
English  apple  orchard  in  the  spring?  When  the  spreading  trees  are 
hoary  with  their  wealth  of  promised  glory,  and  the  mavis  pipes  his  story, 
in  the  spring ! ' ' 

TEST  SET  4 

A  short  story,  arranged  so  as  to  contain  the  following  consonants  and  vowels 
used  in  initial  position,  the  numbers  referring  to  the  number  of  times  each 
was  used:  a(13),  b(9),  d(8),  e(2),  f(8),  g(4),  h(16),  i(8),  j(2),  k(4), 
1(3),  m(4),  n(2),  p(ll),  qu(l),  o(4),  o(l),  oo(3),  r(5),  s(7),  t(8),  u(l), 
w(13),  y(l),  ph  as  f  (1),  wh(l),  th(voiceless,  1),  th(voiced,  21). 

STORY 

Peter,  one  day,  wished  to  make  some  trench  candles.  So  he  took  some  wafers 
of  white  wax,  heated  them  in  a  pan  until  they  dissolved  into  a  thin  liquid ;  then 
he  found  many  of  Phillip's  thick  newspapers.  He  then  bought  a  quire  of 
plain  paper  for  the  outside. 

He  folded  the  papers  over  and  back  and  did  not  forget  the  directions. 
Bringing  from  his  room  some  strips  for  wicks,  he  placed  them  in  the  center  of 
each,  rolling  the  paper  about  it,  and  jamming  it  together,  he  fastened  with 
mucilage  the  outer  edge. 

He  was  going  to  call  George,  but  remembered  that  he  had  gone  to  choir 
practice  at  the  church,  after  the  bell  rang,  and  would  soon  go  by  on  his  way 
back  to  the  shop.  It  would  be  more  pleasure  to  show  him  the  result  of  the 
work  done  by  one's  self,  he  thought.  So  he  dipped  the  paper  candles  in 
paraffin,  and  after  they  dried,  he  lighted  one.    It  gave  forth  a  dim  yellow  light. 


r>  /  \  q:  (^ 


32  IOWA  STUDIES  IN  CHILD  WELFARE 

VII.    SAMPLE  SPEECH  DRILL  CHARTS 

Long:  vowels; 

CHAN  T,«  SAY, 

-LAH-LAY-LEE-LAW-LOH-LOO- 
-HAH  -HAY-HEE-HAW-HOH-HOO- 
-  D  AH -DAY-DEE -DAW-DO H-D 00- 

"MAH-MAY-MEE-MAW-MOH-MOO- 

Vowel  strengrtheninor . 


-ah-AY-  EE  - 


-kah-kaY-KEE  - 


AW- OH-  00 

KAW-KQH-KOO 

Same  With    n.v.f.t.b.gr. 

Exercises  for  Vowel  Drill 

CONSONANT    ATTACK 
-AN -AN  -AN-^AN-AN-AN-CAN 
-AT- AT  -AT  -AT   -AT -AT  -MAT 
-AIN-AIN-AIN-AIN  -  AIN -AIN- RAIN 
-IKE- IKE- IKE -IKE -IKE- IKE-LIKE 
-EW-  EW- EW-EW  -  EW  -  EW  -FEW 
^JRCH-URCH-URCH^JRCH-4JRCH-URCB-CHURCH 
-AM  -  AM  -AM  -AM  -AM-  AM  -JAM 

-  AY  -  AY  -  AY  -  AY  -  AY  -  AY  -  DAY 

Same     with    g.n.b,w,y,t. 

Exercises  for  Consonant  Attack;  Used  Chiefly  with  Stutterers 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH    33 


s     «  Inflection. 


\ 


\ 


OEE 


-O-EE 


-WHO  -  BELLS  -  WINDOW 
-FALL  -  HOME  -  RINGING 
-MILL  -KIT  -  QUICKLY 
-TEN    -    PEAL     -    SISTER 

-1.ArE  you   GOING    HOME   TO    AY? 

-2.1    SAW    YOUR    FATHER    LAST  NlGHIl 

Exercises  for  Developing  Inflection 

<>neech        Building. 

CXhe  too .— 6.\Vhere    is    my ? 

ZThe   ffirl ^ .-7. Who    is ^? 

.The    ice .-8.  May    I    ffo ? 

TThe  store —  ^i    have   a— and  a—. 

SThe    top •  -H).He  bought  a-— and  a— 

Unking. 
I.  John   found   ^   qgw    t^p. 
ZJohn    found    ^  ngy    tpp    and    ^    P^cil. 
iJohn    found    a  n^w     top,  a^ncil  and  ^ok. 
4.  John  found  ^Joo.  ^^nciL  ^_bof)k.  and  ^jri^P. 


Exercises  for  Speech  Building;  Used  in  stimulating  Spontaneous  Speech 
Exercises  in  Phrase  Linking;  Used  in  Work  for  Smooth,  Rhythmical  Speech 


34 


IOWA  STUDIES  IN  CHILD  WELFARE 


fchant; 

I  Say;  ■#  O  ^ 

lshout;_Q|^ij    King    Co.le" 

was  a    merry    old   soul. 
~Great  wide  wonderful,  beautiful 

Ui        '"        "  \!tORLD« 

-With  the  wonderful  w^tIr 
~  round  you   curled: 

-And  THE  wonderful  grass  UPON 

YOUR  BREAST. 

-World. Yojj  are  grandly  and 
beautifully  dressed. 

Exercises  Used  for  Vowel  Drill  on  the  Eounded  Vowel  Sounds  o,  oo  and  the 

Diphthong  eoo 


WORD     DRILLS. 

Initial. 

Final. 

Middle. 

*-  meat  -name 

-aim  4ine 

-amaze      -sense 

-  make  -nine 

-hum  -moon 

-dreamer  -any 

"-  my     -not 

-comb-can 

-summer  -money 

-must  -need 

~foam_seen 

-  tramp      -  sooner 

-move  -number 

-hem  -ton 

-  hammer  -  dinner 

-The    murmur    of    music    makes    him    calm. 
-The    murmuring:     pines    and     the    hemlocks. 
-To    him,     money     seems     most    important. 
-Count     out     nine     new    coins. 
-John    ate     his    dinner     by    the     fountain. 
-The    negro   nurse   crooned   an    ancient    melody. 

Specimen  Chart  Using  m,  n,  in  Initial,  Middle,  and  Final  Position  in  Words 
and  Sentences;  Similar  Charts  Are  Used  for  All  the  Consonants 


PRELIMINARY  STUDY  IN  CORRECTIVE  SPEECH      35 
VIII.     SELECTED  REFERENCES* 

1.  Aiken,  W.  A.  The  Voice.  New  York:  Longmans,  Green  &  Co.,  1910. 
Pp.    59 

2.  Appelt,  a.  Stammering  and  its  Fermanent  Cure.  London:  Methuen  & 
Co.,  1911.     Pp.  234. 

3.  Barth.  Neuere  Ansichten  ilber  Stottern,  Stammeln  und  Horstiimmheit 
1904. 

4.  Bastian,  H.  A.     Treatise  on  Aphasia  and  Other  Speech  Defects.   London: 

Lewis,  1898.     Pp.   366, 

5.  Blanton,  M.,  and  Blanton,  S.  Speech  Training  for  Children.  New 
York:  Century  Co.,  1919.     Pp.  261. 

6.  Bleummel,  C.  S.  Stammering  and  Cognate  Defects  of  Speech.  New 
York:  Stechert,  1913,  I,  IL     Pp.  715. 

7.  Collins,  J.  The  Genesis  and  Dissolution  of  the  Faculty  of  Speech.  A 
Clinical  and  Fsychological  Study  of  Aphasia.     New  York:      Macmillan, 

1893.  Pp.  439. 

8.  Fletcher,  J.  M,  The  Etiology  of  Stuttering.  J.  Amer.  Med.  Assn., 
Apr.  8,  1916  (64),  1079. 

9.  Proeschels,  E.  Lehrbuch  der  Sprachheilkunde.  Leipzig  u  Wien:  Deut- 
ieke,  1913.     Pp.  397. 

10.  GuTZMANN,  H.     Des  Kindes  Sprache  und  Sprachfehler.    Leipzig:  Weber, 

1894.  Pp.  264. 

11.  GxJTZMANN,  H.     Sprachheilkunde.     Berlin:   Fischer,  1912.    Pp.  648. 

12.  KussMAUL,  A.  Disturbances  of  Speech.  Ziemssen's  Cyclopaedia  of  the 
Fractice  of  Medicine.     New  York:  Wood  &  Co.,  1877   (14),  581-865. 

13.  Maas,  p.  Die  Sprache  des  Kindes  und  ihre  Storungen.  Wiirzbnrg: 
Kabitzsch,  1909.     Pp.  125. 

14.  Mackenzie,  M.  Hygiene  of  the  Vocal  Organs.  New  York:  Werner,  1891. 
Pp.  285. 

15.  Makuen,  G.  H.  a  Study  of  1,000  Cases  of  Stammering  with  Special  Eef- 
erence  to  the  Etiology  and  Treatment  of  the  Affection.  Therapeutic  Gas., 
June,  1914.     Eeprint,  U.  S.  Bur.  of  Educ,  Bull.  4,  1915,  95-98. 

16.  Merry,  G.  N.  Outlines  of  the  Frinciples  of  Speech.  Monograph,  State 
Univ.  of  Iowa,  1919,  Chap  3   (Breathing). 

17.  Mills,  W.  Voice  Production.  Philadelphia :  Lippincott  Co.,  1913,  Pp. 
294. 

18.  Nadoleczny,  M.  Disorders  of  Speech  and  Fhonation  in  Childhood. 
Shaw  &  Lafetra,  The  Diseases  of  Children.  Philadelphia:  Lippincott, 
1914   (7),  359-480. 

19.  Potter,  S.  O.  L.,  Speech  and  its  Defects.  Philadelphia:  Blakiston  Son 
&  Co.,  1882.     Pp.  114. 

20.  EoBBiNS,  S.  A  Flethysmo graphic  Study  of  Shod-  and  Stammering. 
Amer.  J.  of  Fhysiol.,  1919,    (18),  285-330. 

21.  EoiiMA,  G.     La  Parole  et  les  troubles  de  la  parole.     Paris:   1907. 

22.  Scharr,  J.     Die  Behandlung  Stotternder.     Hanover:   Soedel,  1919. 


*.Sug-gt-slioriS  were  received  frim  Dr.  .7.  E.  Wallin  in  tlir  propnration  of  this  list. 


36  IOWA  STUDIES  IN  CHILD  WELFARE 

23.  Scripture,  E.  W.     The  Elements  of  Experimental  Plwnetics.    New  York: 
Scribner,  1902.     Pp.  627. 

24.  ScRiPTUKE,  E.  W.     Researches  in  Experimental  Phonetics.     Washington, 
D.  C:  Carnegie  Institution,  1906.     Pp.  204. 

25.  Scripture,  E.  W.    Stuttering  and  Lisping.    New  York:  Macmillan,  1914. 
Pp.  251. 

26.  Scripture,  M.  K.,  and  Jackson,  E.    Manual  for  the  Correction  of  Speech 
Disorders.    Philadelphia:  Davis,  1919.     Pp.  236. 

27.  Still,  G-.  F.     Disorders  of  Speech.     Common  Diseases  and  Disorders  of 
Childhood.    London:  Prowde,  1915,  740-754. 

28.  Struempell,    D.      Die    EntwicMung    der   Sprache    und    die    aphatischen 
Sprachstorungen.    Zsch.  f.  Pad.  Psych.,  1916,  6-21. 

29.  Swift,  W.  B.     Speech  Disorders  in  School  Children  and  How  to  Treat 
Them.    Boston  and  New  York:  Houghton  Mifflin,  1918.     Pp.  128. 

30.  Tredgold,  a.  F.     Mental  Deficiency.     New  York:  Wood,  1916,  128-164. 

31.  Wallin,   J.  E.     Report   on   Speech  Defectives  in  the   St.   Louis  Public 
Schools.     St.  Louis:  Ann.  Sep.  of  the  Board  of  Educ,  1915-16. 

32.  Wallin,  J.  E.     Theories  of  Stuttering.    J.  of  Appl.  Psychol.,  1917,  349- 
367. 

33.  Wyllie,  J.     The  Disorders  of  Speech.     Edinburgh:  Oliver  &  Boyd,  1894. 
Pp.  495. 

34.  Wrescpiner.      Die    SpracJie    des    Kindes.      Ziirieh:    Art    Institut.      Orell 
Flissli,  1912. 


University  of 
Connecticut 

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